Endoscopic system for winding and inserting a mesh

ABSTRACT

An endoscopic system for winding and inserting a mesh into an abdominal cavity of a patient is provided. The endoscopic system includes an introducer having an elongated shaft extending distally therefrom. The shaft includes a split portion that defines an opening therealong. The split portion is configured to support the mesh within the opening. A furler defining a lumen is engageable with the split portion of the shaft and configured to exert a radial force onto the mesh that is supported by the split portion. Rotation of one of the furler and introducer with respect to the other winds the mesh inside the furler to a diameter smaller than a diameter of the lumen of the furler.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalPatent Application No. 61/915,730, filed Dec. 13, 2013, the entiredisclosure of which is incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to an endoscopic system for winding andinserting mesh. More particularly, the present disclosure relates to anendoscopic system including an introducer and furler configured to windand insert a mesh into an abdominal cavity of a patient.

2. Description of Related Art

Current mesh application typically requires a scrub nurse or otheroperating room personal to open, at the operating table, a pre-packagedsterile container containing a mesh, which may have a flatconfiguration. A surgeon will often remove the mesh from the openedcontainer and mark the mesh with a marker and then roll or wind the mesh(e.g., like a scroll). The wound mesh is inserted into an abdominalcavity of a patient through an access port, e.g., a large diameter port(10 or 12 mm trocar) or through an open port site from which a trocarhas been removed. In the latter case, after the mesh is inserted intothe abdominal cavity, the trocar may be reinserted into the open portsite to reenter the abdominal cavity. This additional step ofreinserting the trocar adds time to the surgical procedure and cansometimes be difficult because of tissue plane movement.

While the aforementioned method for winding and inserting a mesh into anabdominal cavity of a patient may be satisfactory, a need exists for asimpler and less time-consuming method.

SUMMARY

As can be appreciated, an endoscopic instrument including an introducerand furler configured to wind (or roll) and insert a mesh into anabdominal cavity may prove useful in the surgical arena.

Embodiments of the present disclosure are described in detail withreference to the drawing figures wherein like reference numeralsidentify similar or identical elements. As used herein, the term“distal” refers to the portion that is being described which is furtherfrom a user, while the term “proximal” refers to the portion that isbeing described which is closer to a user.

An aspect of the present disclosure provides an endoscopic system forwinding and inserting a mesh into an abdominal cavity of a patient. Theendoscopic system includes an introducer having an elongated shaftextending distally therefrom. The shaft includes a split portion thatdefines an opening therealong. The opening of the split portion mayextend to a distal tip of the shaft. The split portion is configured tosupport the mesh within the opening. A furler defining a lumen isengageable with the split portion of the shaft and configured to exert aradial force onto the mesh that is supported by the split portion.Rotation of one of the furler and introducer with respect to the otherwinds the mesh inside the furler to a diameter smaller than a diameterof the lumen of the furler.

The furler may be movable along the shaft to at least partially coverthe mesh when the mesh is positioned within the split portion of theshaft. The furler may have an elongated configuration and a longitudinalslit extending along a length thereof. The longitudinal slit of thefurler may be configured to receive the mesh when the mesh is supportedon the split portion of the shaft.

The furler may include a tapered-down distal end defined by a v-shapedopening. The furler may include a flared proximal end having a conicalconfiguration. The furler may include a medial portion having a tabbedcut-out defined by three side walls and a living hinge. The tabbedcut-out may be depressible to reduce the diameter of the lumen of thefurler and apply the radial force to the mesh as the mesh is beingwound.

The furler may include a pair of tension tabs extending radially from acenter of the furler. Alternatively, the furler may include a pair oftension tabs extending tangentially from a center of the furler.

The shaft of the introducer may include an articulating portionpositioned proximally in relation to the split portion. The endoscopicsystem may also include a sheath which is movable along the shaft andslidable within the furler.

Another aspect of the present disclosure provides a method that utilizesthe endoscopic system for inserting a mesh into an abdominal cavity of apatient. The mesh is, initially, positioned through the split portion ofthe shaft. The furler, is then positioned over the split portion of theshaft to at least partially cover the mesh. Thereafter, one of thefurler and shaft is rotated with respect to the other to wind the meshinside the furler. A radial force is applied to the mesh, by reducingthe diameter of the furler, as the mesh is being wound in the furler.

The furler including the wound mesh may then be inserted through anaccess opening in a patient. Further, the shaft may be pushed distallyin relation to the access opening to engage a proximal end of the furlerwith the access opening to position the mesh into the abdominal cavityof a patient and unwind the mesh.

Positioning the mesh through the split portion of the shaft may furtherinclude positioning the mesh within the opening that extends along thesplit portion of the shaft. Moreover, prior to positioning the furlerover the split portion of the shaft to at least partially cover themesh, the mesh may be folded over the split portion of the shaft and atleast a portion of the folded mesh may be positioned within thelongitudinal slit of the furler. Rotating one of the furler and shaftwith respect to the other to wind the mesh inside the furler may furtherinclude depressing the tabbed cut-out of the furler to apply the radialforce to the mesh as the mesh is being wound, thereby facilitating atight wind of the mesh and preventing unwinding of the mesh.

BRIEF DESCRIPTION OF THE DRAWING

Various embodiments of the present disclosure are described hereinbelowwith references to the drawings, wherein:

FIG. 1A is a perspective view of an endoscopic system including anintroducer, a furler and a mesh according to an embodiment of theinstant disclosure;

FIG. 1B is a perspective view of the endoscopic system shown in FIG. 1Awith parts separated;

FIG. 2 is a perspective view of the introducer shown in FIGS. 1A and 1B;

FIG. 3A is a perspective view of the furler shown in FIGS. 1A and 1B;

FIG. 3B is a partial, perspective view of a furler according to analternate embodiment of the instant disclosure;

FIG. 4 is an indicated area of detail shown in FIG. 3A;

FIG. 5 is an indicated area of detail shown in FIG. 3A;

FIG. 6 is an indicated area of detail shown in FIG. 3A;

FIGS. 7-11 are perspective views illustrating a method of use of theendoscopic system shown in FIG. 1A;

FIG. 12 is a perspective view of an endoscopic system including anintroducer, a furler and a mesh according to another embodiment of theinstant disclosure;

FIG. 13 is a perspective view of the furler shown in FIG. 12;

FIG. 14 is a perspective view of a furler according to anotherembodiment of the instant disclosure; and

FIGS. 15-18 are perspective views illustrating a method of use of theendoscopic system shown in FIG. 12.

DETAILED DESCRIPTION

Detailed embodiments of the present disclosure are disclosed herein;however, the disclosed embodiments are merely examples of thedisclosure, which may be embodied in various forms. Therefore, specificstructural and functional details disclosed herein are not to beinterpreted as limiting, but merely as a basis for the claims and as arepresentative basis for teaching one skilled in the art to variouslyemploy the present disclosure in virtually any appropriately detailedstructure.

As discussed above, an endoscopic system including an introducer andfurler configured to wind (or roll) and insert a mesh into an abdominalcavity of a patient may prove useful in the surgical arena, and such anendoscopic system is described herein.

FIGS. 1A and 1B illustrate an endoscopic system 10 that includes anintroducer 12 and a furler 14 which are configured to wind and insertone or more types of mesh 16 into an abdominal cavity of a patient.Suitable meshes include, but are not limited to, mesh that are formedvia casting, molding, needle-punching, hooking, weaving, rolling,pressing, bundling, braiding, spinning, piling, knitting, felting,drawing, splicing, cabling, extruding, and/or combinations thereof. Insome embodiments, the mesh 16 may further include reactive and/or may bebioabsorbable or non-bioabsorbable. The mesh 16 may have a thickness offrom about 0.2 mm to about 5 mm, in embodiments, from about 1 mm toabout 3 mm. Strands of the mesh 16 may be spaced apart to form pores offrom about 100 microns to about 2000 microns in diameter, inembodiments, from about 200 microns to about 1500 microns, in otherembodiments, from about 750 microns to about 1250 microns in diameter.Examples of various meshes include those disclosed in U.S. Pat. Nos.6,596,002; 6,408,656; 7,021,086; 6,971,252; 6,695,855; 6,451,032;6,443,964; 6,478,727; 6,391,060; and U.S. Patent Application PublicationNo. 2007/0032805, the entire disclosures of each of which areincorporated by reference herein.

Filaments of the mesh 16 may be monofilament or multi-filament. Wheremulti-filament constructs are utilized, they may be plaited, braided,weaved, twisted, and the like, or laid parallel to form a unit forfurther construction into a fabric, textile, patch, mesh, and the like.The distribution of the filaments or strands may be random or oriented.

The mesh 16 may include natural or synthetic, bioabsorbable ornon-bioabsorbable materials including those listed below. Suitablemeshes include a collagen composite mesh such as PARIETEX™ (TycoHealthcare Group LP, d/b/a Covidien, North Haven, Conn.) may be used.PARIETEX™ Composite mesh is a 3-dimensional polyester weave with aresorbable collagen film bonded on one side.

In embodiments, the mesh 16 component may be a substantially flat sheet(as described in the illustrated embodiments). In other embodiments, themesh 16 may be cylindrical in shape.

In embodiments, the mesh 16 may act as a tissue scaffold, therebyproviding a means for tissue integration/ingrowth. Such meshes arecapable of providing cells with growth and development components. Thus,where a mesh is utilized as a tissue scaffold, it may assist in nativetissue regrowth by providing the surrounding tissue with needednutrients and bioactive agents. In some embodiments, as discussedherein, the mesh 16 itself may include a natural component, such ascollagen, gelatin, hyaluronic acid, combinations thereof, and the like,and thus the natural component may be released or otherwise degrade atthe site of implantation as the tissue scaffold degrades.

Continuing with reference to FIGS. 1A and 1B, the endoscopic system 10may include or be utilized with one or more suitable access ports (e.g.,trocar or radial sleeve with access openings ranging from about 5 mm toabout 15 mm) to access the abdominal cavity of a patient to insert awound mesh 16. Alternatively, the endoscopic system 10 can be utilizedto insert the wound mesh 16 directly into the abdominal cavity throughan incision in a patient.

FIG. 2 is a perspective view of the introducer 12. The introducer 12includes a generally elongated configuration and has a handle 18, whichmay be ergonomically shaped to facilitate grasping and rotation of theintroducer 12. In the illustrated embodiments, for example, a pluralityof rib portions 20 are provided along a length of the handle 18 of theintroducer 12 to facilitate grasping and rotation of the introducer 12.

Continuing with reference to FIG. 2, a shaft 22 extends from the handle18 of the introducer 12. In the illustrated embodiments, the shaft 22includes a first shaft portion 24 that extends distally from a distalend of the handle 18. The first shaft portion 24 connects to or supportsan articulating or flexing portion 26 (shown schematically in FIG. 2)from which a second shaft portion 28 extends distally. The second shaftportion 28 pivotally connects to the articulating or flexing section 26so that the second shaft portion 28 can be moved to one or morearticulated or flexed configurations for positioning the mesh 16 withinthe abdominal cavity of a patient. In embodiments, the first and secondshaft portions 24, 28 can be directly coupled to one another and thearticulating or flexing portion 26 may be omitted.

The first shaft portion 24 has a generally elongated, cylindricalconfiguration and is configured to support the furler 14. The firstshaft portion 24 has an outer diameter that allows the furler 14 to bemoved along the first shaft portion 24 and over the mesh 16, which mesh16 will be secured to or hung on the second shaft portion 28 and in afolded configuration, described in detail below. During insertion of thesecond shaft portion 28 into an access opening to insert the wound mesh16 into the abdominal cavity, due to the size of the outer diameter ofthe first shaft portion 24, the furler 14 is able to move along thefirst shaft portion 24 to release the mesh 16 from the second shaftportion 28, also described in detail below.

The second shaft portion 28 may take the form of a splined shaftincluding two tines 30 a, 30 b that extend along a length of the secondshaft portion 28. The two tines 30 a, 30 b are spaced-apart from oneanother and define a longitudinal opening 32 therebetween to form a forkor split configuration. The longitudinal opening 32 extends to a distaltip 34 that is configured to receive the mesh 16 so that the mesh 16 canbe temporarily secured between the two tines 30 a, 30 b of theintroducer 12.

In one method of use, once the mesh 16 is inserted between the two tines30 a, 30 b of the introducer 12, the mesh 16 can be folded over the twotines 30 a, 30 b and the furler 14 can be positioned along the two tines30 a, 30 b to cover the mesh 16, which can then be wound within thefurler 14. Thereafter, the wound mesh 16 can be inserted into theabdominal cavity of a patient where the mesh 16 can be positionedadjacent target tissue with the articulating section 26 and/or releasedfrom between the tines 30 a, 30 b through the opening 32.

The introducer 12 including the handle 18 and first and second shaftportions 24, 28 may be formed from any suitable material, e.g., plastic,metal, ceramic, etc. For example, in embodiments, the handle 18 andfirst shaft portion 24 may be formed from a relatively rigid plastic andthe tines 30 a, 30 b of the second shaft portion 28 may be formed fromsurgical steel. If the articulating portion 26 is provided with theintroducer 12, the articulating portion 26 can be formed from plasticand/or surgical steel.

Turning now to FIGS. 3A and 4-6, the furler 14 is illustrated and willbe described. The furler 14 can be formed from the same materials usedto form the introducer 12. In the illustrated embodiments, the furler 14may be formed from a relatively rigid plastic or stainless steel.

The furler 14 has a generally tubular configuration including proximaland distal ends 36, 38, respectively, and a medial portion 46 extendingtherebetween. Extending along the medial portion 46 of the furler 14from the proximal end 36 to the distal end 38 is a longitudinal slot 37.The longitudinal slot 37 is configured to receive the mesh 16 when themesh 16 is folded over the tines 30 a, 30 b so that the mesh 16 can beinserted into the furler 14 and wound.

Referring to FIG. 4, the proximal end 36 includes a flared neck portion40 that tapers outwardly to define an opening or lumen 42, which extendsthrough the furler 14. The flared neck portion 40 has a conicalconfiguration and includes a diameter that is greater than a diameter ofthe medial portion 46 and the distal end 38. The diameter of the flaredneck portion 40 is also greater than a diameter of a proximal end of theaccess opening. This difference in diameter causes interference betweenthe proximal end of the access opening and the flared neck portion 40 ofthe furler 14, which prevents the furler 14 from passing through theaccess opening as the second shaft portion 28 is being pushed distallytherethrough to insert the wound mesh 16 into the abdominal cavity.Accordingly, the force that a user is applying to the introducer 12after the flared neck portion 40 engages the proximal end of the accessopening overcomes the frictional force between the wound mesh 16 and thefurler 14 causing the wound mesh 16 to exit the furler 14 into theabdominal cavity of the patient. Additionally, the flared neck portion40 provides a guide or funnel-like structure to facilitate alignment andinsertion of the distal tip 34 of the second shaft portion 28 into thefurler 14.

Referring to FIG. 5, the distal end 38 of the furler 14 includes atapered down configuration having a generally v-shaped opening 44, whichfacilitates sliding the distal end 38 over the mesh 16 when the mesh 16is folded over the tines 30 a, 30 b of the second shaft portion 28. Thetapered down distal end 38 of the furler 14 also facilitates insertingthe distal end 38 of the furler 14 into the access opening. The distalend 38 of the furler 14 may include other configurations not disclosedherein.

Referring to FIG. 6, the medial portion 46 of the furler 14 includes atabbed cut-out 48 defined by three side walls 50 a-50 c and a livinghinge 52, which allows the tabbed cut-out 48 to be depressed by a userto apply a radial force “F” normal or perpendicular (FIGS. 6 and 8) tothe mesh 16 as the mesh 16 is being wound.

More particularly, in one embodiment of use, the tabbed cut-out 48 canbe depressed and held by the user to effectively decrease the insidediameter of the furler 14 (i.e., to decrease a diameter of the lumen 42)to a point where the tabbed cut-out 48 comes into contact with the mesh16. As the mesh 16 is being wound, and increasing in diameter within thefurler 14, the tabbed cut-out 48 follows an outside diameter of the mesh16 such that the application of the radial force “F” to the mesh 16provides a tight wind of the mesh 16 (and prevents unwinding of the mesh16). The tightly wound mesh 16 can be inserted into the abdominal cavityof the patient through a relatively smaller access opening, e.g., trocarwith 5 mm opening, as compared to a wound mesh 16 that has not been moretightly wound due to the use of tabbed cut-out 48.

In embodiments, the tabbed cut-out 48 can be omitted and the furler 14can be provided with a window 47 (FIG. 3B). In one embodiment of use, auser can position their thumb (or one of their fingers) within thewindow 47 to apply a radial force “F” normal or perpendicular to themesh 16 as the mesh 16 is being wound to effectively decrease the insidediameter of the furler 14 (i.e., to decrease a diameter of the lumen 42)to a point where the user's thumb comes into contact with the mesh 16.As the mesh 16 is being wound, and increasing in diameter within thefurler 14, the user's thumb follows an outside diameter of the mesh 16such that the application of the radial force “F” to the mesh 16provides a tight wind of the mesh 16 (and prevents unwinding of the mesh16). The tightly wound mesh 16 can be inserted as described above.

Referring to FIGS. 7-11, a method of use of the endoscopic system 10 isnow described. The components of the endoscopic system 10 may bepackaged and shipped (in a sterile environment) separately, or togetheras a kit. In the latter instance, for example, the kit may include oneor more of the aforementioned radial sleeves or trocar, the introducer12, the furler 14 and the mesh 16. Conversely, the kit may be soldwithout the radial sleeves or trocar.

According to one embodiment of use, the furler 14 is, initially,positioned on the first shaft portion 24 towards the handle 18, with thetines 30 a, 30 b exposed (see FIG. 1A for example) or extending distallyof the furler 14. The mesh 16 may be placed flat between the tines 30 a,30 b, with the tines 30 a, 30 b in the center of the mesh 16. It isnoted, the mesh 16 can be provided with a center-line “CL” to facilitatepositioning the mesh 16 between the tines 30 a, 30 b (see FIG. 1B forexample). The mesh 16 is then folded in half along the tines 30 a, 30 b(FIG. 7). In embodiments, such as when the endoscopic system 10 is soldas a kit, the mesh 16 can be pre-positioned between the tines 30 a, 30 bof the second shaft portion 28 and pre-wound within the furler 14.

The furler 14 is then slid distally along the first and second shaftportions 24, 28 with the longitudinal slot 57 of the furler 14 aligningwith the folded mesh 16 so that the furler 14 covers the tines 30 a, 30b with the two halves of the mesh 16 hanging out of the longitudinalslot 57 thereof (FIG. 7). It is noted that the furler 14 may bepositioned completely or partially over the mesh 16 to wind the mesh 16.

In one hand a surgeon holds the furler 14, and with the other handrotates the handle 18 of the introducer 12, thereby rolling or windingthe mesh 16 within the furler 14 (FIG. 8). Alternatively, the handle 18of the introducer 12 can be held while the furler 14 is rotated withrespect to the handle 12. In either instance, the tabbed cut-out 48 canbe depressed as the mesh 16 is being wound in the furler 14 to provide atight wind of the mesh 16. Desirably, the introducer 12 is rotated in adirection toward the sidewall 50 b of the tabbed cut-out 48 (see FIG. 6)of the furler 14. Once the mesh 16 is fully wound, the introducer 12including the furler 14 with the wound mesh 16 is inserted into a trocar54 (FIG. 9).

The furler 14 acts as a sheath which protects the mesh 16 as the mesh 16is being inserted through the trocar 54. As the introducer 12 is beinginserted into the trocar 54, the flared neck 40 on the proximal end 36of the furler 14 contacts the proximal end of the trocar 54 preventingthe furler 14 from going past a proximal end of the trocar 54 andcompletely entering the trocar 54 (FIG. 10). As the surgeon continues toinsert the introducer 12 via the handle 18, the tines 30 a, 30 b advancethe mesh 16 past the furler 14/trocar 54 and into the abdominal cavityof the patient, where the mesh 16 naturally unwinds (FIG. 10). At thispoint the surgeon can use the introducer 12 to roughly position (e.g.,via the articulating portion 26 of the introducer 12) the mesh 16 forinitial tacking, or simply remove the introducer 12, thereby allowingthe mesh 16 to gently drop into the abdominal cavity (FIG. 11).

In accordance with the instant disclosure, the endoscopic system 10allows for tight winding of the mesh 16 so that the mesh 16 can beinserted through trocars or radial sleeves that include relatively smallaccess openings (e.g., 5 mm). As can be appreciated, this allows thesurgeon to use smaller access ports, which, in turn, may prevent portsite herniation and post-operative pain typically associated with largerport sites. Additionally, the furler 14 protects the mesh 16 fromprematurely coming in contact with skin or underlying tissue.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. For example, the flared neck portion 40 of the furler 14 isone of many ways to create a stop that prevents the furler 14 fromcompletely entering the access opening. For example, any number of tubeforming operations could be utilized to achieve the same function. Inembodiments, a flange (not shown) can be provided along an exteriorsurface of the furler 14 or a tab that extends radially outward from thefurler 14 can also be used to create a stop that prevents the furler 14from completely entering and/or exiting the access opening.

In embodiments, the introducer 12 may be provided with a pin or othersuitable device (not explicitly shown) that aligns with the longitudinalslot 37 on the furler 14 to engage the longitudinal slot 37, therebypreventing the furler 14 from coming off of the introducer 12 uponremoval from the access opening.

In embodiments, the handle 18 of the introducer 12 can have a trigger orbutton (not explicitly shown) for automatic deployment/unwrapping of themesh 16, or can be powered to dispense/unravel/unwind the mesh 16intra-abdominally with the push of the button.

Referring to FIG. 12 an endoscopic system 110 in accordance with anotherembodiment of the present disclosure is illustrated. The endoscopicsystem 110 is similar to the endoscopic system 10. Accordingly, onlythose components and operative features that are unique to theendoscopic system 110 are described herein.

The endoscopic system 110 includes a sheath 113 that is positionablealong a first and second shaft portions 124, 128 of an introducer 112.

The endoscopic system 110 includes a furler 114 that is substantiallysimilar to the furler 14 (FIG. 13). Unlike the furler 14, however, thefurler 114 illustrated in FIG. 13 is not an “in-line” furler as thefurler 14. In other words, the furler 114 is not configured to remainattached to the introducer 112 when a mesh 116 is being inserted throughan access port, e.g., the trocar 54. Accordingly, the furler 114 neednot include the flared neck portion 40, as this feature (e.g., a flaredneck portion 140) is provided on the sheath 113 (see FIG. 12).

As illustrated in FIG. 13, the furler 114 includes a longitudinal slot137 that is defined by a pair of spaced-apart fins or tension tabs 138a, 138 b. The tension tabs 138 a, 138 b define the longitudinal slot 137along a center of the furler 114 which provides a center “lead-in” forthe folded mesh 116 into the furler 114 (FIG. 13). Alternatively, atleast one of the tension tabs 138 a, 138 b extends along a tangent ofthe furler 114 which provides a tangent “lead-in” for the folded mesh 16into the furler 114 (FIG. 14).

The longitudinal slot 137 is defined by the tension tabs 138 a, 138 band is wider than the longitudinal slot 37 on the furler 14. Thiswideness of the longitudinal slot 137 facilitates inserting the foldedmesh 116 into the furler 114, as the mesh 116 is led into the furler 114from the center of the furler 114 or the tangent along the furler 14 asopposed to the distal end 38 of the furler 14 described above. Moreover,when the tension tabs 138 a, 138 b are moved towards one another, thetension tabs 138 a, 138 b provide an additional force to the mesh 116,thereby facilitating an even tighter wind of the mesh 116.

Referring to FIGS. 15-18, a method of use of the endoscopic system 110is now described. The components of the endoscopic system 110 may bepackaged and shipped separately, or together as a kit. In the latterinstance, for example, the kit may include one or more of theaforementioned radial sleeves or trocar 54, the introducer 112, thefurler 114, the sheath 113 and the mesh 116.

The sheath 113 is, initially, positioned on the first shaft portion 124adjacent a handle 118, with the tines 130 a, 130 b exposed or extendingdistally of the sheath 113 (see FIG. 12 for example). The mesh 116 maybe placed flat between the tines 130 a, 130 b, with the tines 130 a, 130b in the center of the mesh 116 (FIG. 15). The mesh 116 is then foldedin half along the tines 130 a, 130 b and the mesh 116 is then insertedinto the longitudinal slot 137 of the furler 114 (FIG. 16), which caninclude either of the configurations of the tensions tabs 138 a, 138 bshown in FIGS. 13 and 14.

In one hand a surgeon holds the furler 114, and with the other handrotates the handle 118 of the introducer 112, thereby rolling or windingthe mesh 116 within the furler 114. The tabbed cut-out 148 can bedepressed (as described above) as the mesh 16 is being wound in thefurler 114 to provide a tight wind of the mesh 16. Alternatively, or inaddition thereto, the tension tabs 138 a, 138 b can be moved towards oneanother, which can also facilitate in providing a tight wind of the mesh116. Once the mesh 116 is fully wound, the sheath 113 is moved along thefirst and second shaft portions 124, 128 so that the sheath 113 ispositioned within the furler 114 and over the tines 130 a, 130 bincluding the wound mesh 116 (FIG. 17). For clarity, the sheath 113 isnot explicitly shown positioned within the furler 114. The introducer112 including the sheath 113 with the wound mesh 116 is then insertedinto the trocar 54.

As the introducer 112 is being inserted into the trocar 54, the flaredneck portion 140 of the sheath 113 prevents the sheath 113 from goingpast the trocar 54. As the surgeon continues to insert the introducer112 via the handle 118, the tines 130 a, 130 b advance the mesh 116 pastthe sheath 113/trocar 54 and into the abdominal cavity of the patient,where the mesh 116 naturally unwinds (FIG. 18). At this point thesurgeon can use the introducer 112 to roughly position (e.g., via anarticulating portion 126 of the introducer 112) the mesh 116 for initialtacking, or simply remove the introducer 112, thereby allowing the mesh116 to gently drop into the abdominal cavity.

As can be appreciated, the same advantages described above with respectto the endoscopic system 10 are attainable with the endoscopic system110.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of particular embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. An endoscopic system for winding and inserting amesh into an abdominal cavity of a patient, comprising: an introducerhaving an elongated shaft extending distally therefrom, the shaftincluding a split portion defining an opening therealong, the splitportion configured to support the mesh within the opening; a furlerdefining a lumen and being engageable with the split portion of theshaft and configured to exert a radial force onto the mesh that issupported by the split portion, wherein the furler includes a medialportion having a tabbed cut-out defined by three side walls and a livinghinge; wherein rotation of one of the furler or introducer with respectto the other winds the mesh inside the furler to a diameter smaller thana diameter of the lumen of the furler; and wherein the tabbed cut-out isdepressible to reduce the diameter of the lumen of the furler and applya normal force to the mesh as the mesh is being wound within the furler.2. The endoscopic system according to claim 1, wherein the furler ismovable along the shaft to at least partially cover the mesh when themesh is positioned within the split portion of the shaft.
 3. Theendoscopic system according to claim 1, wherein the furler has anelongated configuration and a longitudinal slit extending along a lengththereof.
 4. The endoscopic system according to claim 3, wherein thelongitudinal slit of the furler is configured to receive the mesh whenthe mesh is supported on the split portion of the shaft.
 5. Theendoscopic system according to claim 1, wherein the furler includes atapered-down distal end defined by a v-shaped opening.
 6. The endoscopicsystem according to claim 1, wherein the furler includes a flaredproximal end having a conical configuration.
 7. The endoscopic systemaccording to claim 1, wherein the furler includes a pair of tension tabsextending radially from a center of the furler.
 8. The endoscopic systemaccording to claim 1, wherein the furler includes a pair of tension tabsextending tangentially from a center of the furler.
 9. The endoscopicsystem according to claim 1, wherein the shaft includes an articulatingportion positioned proximally in relation to the split portion.
 10. Theendoscopic system according to claim 1, wherein the opening of the splitportion extends to a distal tip of the shaft.
 11. The endoscopic systemaccording to claim 1, further including a sheath which is movable alongthe shaft and slidable within the furler.